Postpartum Weight Reduction Research Articles

The impact of a lifestyle intervention on postpartum weight retention among US Hispanic women with overweight and obesity

IntroductionTo evaluate the effect of a culturally-modified, motivationally-targeted, individually-tailored lifestyle intervention on postpartum weight retention among Hispanic women with overweight/obesity. Materials and methodsProyecto Mamá was a randomized controlled trial conducted in western Massachusetts (2014–2020). Hispanic women with overweight/obese pre-pregnancy BMI (n = 148) were randomized in early pregnancy to a Lifestyle Intervention (LI) or a Health & Wellness (HW) comparison arm. The LI was based upon theoretical concepts, used a low-cost, high-reach strategy, and focused on healthy exercise and diet with follow-up through 12-months postpartum. The primary outcome of change in weight was calculated as the difference between pre-pregnancy weight and 6-week, 6-month, and 12-month postpartum weight. The secondary outcome was achievement of 5 % weight reduction from pre-pregnancy weight. Retention was 68.2 % in the overall postpartum period and 31.0 % at 12-months. ResultsIn intent-to-treat analyses, compared to the HW arm, there was no difference in postpartum weight retention at 6-weeks (0.0 kg, 95 % CI: −3.4, 3.5), 6-months (-1.8 kg, 95 % CI: −5.6, 2.0), or 12-months (-2.0 kg, 95 % CI: −7.0, 3.1). In a secondary complete case analysis, compared to the HW arm, the LI arm had 5.5 times higher odds of meeting the postpartum weight reduction goal (aOR = 5.5, 95 % CI: 1.7, 17.9) adjusting for pre-pregnancy weight. ConclusionsA lifestyle intervention among at-risk Hispanic women with overweight/obesity had no overall impact on postpartum weight, but a beneficial impact among those who completed the trial. Future studies should focus on increasing the feasibility and acceptability of the intervention in this at-risk population.

A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol.

The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.

Longer duration of exclusive breastfeeding reduces maternal weight retention: results from the CLaB study

Abstract Objectives: to evaluate the relation between breastfeeding and postpartum weight reten-tion. Methods: this prospective cohort study involved 641 newborns and their mothers, followed up to twelve months postpartum. Data were collected from June 2015 to February 2017. In the first interview, we investigated data regarding socioeconomic and demographic characteristics, obstetric history, weight, and gestational age of the infant at birth. Maternal weight and breastfeeding status were obtained at 3, 6, 9 and 12 months postpartum at the mother’s home. A descriptive analysis of maternal weight retention according to the lactation status was performed. Multiple linear regression models evaluated the effect on exclusive breastfeeding and total breastfeeding duration on maternal weight retention at 6 and 12 months postpartum, considering potential confounders. Results: 512 and 490 mothers were evaluated at six months and at twelve months post-partum, and the mean weight retention was 1.79 (SD=5.52) and 1.69 (SD=6.69) kg, respectively. Regardless of the confounders, the mean postpartum weight reduction for each day of exclusive breastfeeding was 11 (CI95%= -0.019 to -0.003) and 16 grams (CI95%= -0.026 to -0.007) for 6 and 12 months, respectively. The total maternal breastfeeding duration had the same effect. Conclusions: longer periods of exclusive breastfeeding and total breastfeeding are associated with lower postpartum weight retention.

Abstract P076: Genetic Predisposition to Hemoglobin A1 c , Postpartum Weight Reduction, and Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes

Introduction: Hemoglobin A 1c (HbA 1c ) is a common marker for glycemic control and a major risk factor for diabetes and cardiovascular disease. Hypothesis: We examined whether the genetic variation predisposing to HbA 1c affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy. Methods: This is a longitudinal study in Tianjin, China. We genotyped 10 genome-wide association study-identified HbA 1c single nucleotide polymorphisms and assessed weight at 1 to 5 years postpartum and changes in glycemic traits in 1156 women with prior GDM. The genetic risk score was calculated based on 10 HbA 1c -associated loci. Main Outcome Measures: The main outcome measure was postpartum glycemic changes. Results: The HbA 1c genetic risk score significantly interacted with postpartum weight reduction on changes in 2-h glucose and HbA 1c (P for interaction = 0.02 and 0.03; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥8kg/y, the genetic risk score was associated with decreased HbA 1c . The association between postpartum weight reduction and glycemic improvement was more significant among women with a lower genetic risk score. Conclusions: In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to HbA 1c may interact with postpartum weight reduction on long-term glycemic changes. Figure 1. Changes in glycemic traits according to weight reduction and HbA 1C genetic risk score tertiles.

Maternal Outcomes of Breastfeeding in King Abdulaziz University Hospital, Saudi Arabia

Breastfeeding has a great efficacy on the growing infant, as well as the mother. It has been suggested that breastfeeding promotes postpartum weight loss. Furthermore, it may alter the risk of developing postpartum depression. The aim of this study is to further understand the adherence and the effect of breast milk feeding on developing a postpartum depression and calculating the postpartum weight reduction percentage in comparison to pre-pregnancy weight. A cross-sectional study was conducted in King Abdulaziz University Hospital among 153 mothers, whose infants are less than two years of age. Data were collected by interviewing the mothers using a standard questionnaire designed for the study and the HAMD depression scale with anthropometric measures. 85.62% of the study sample had breastfed, 43.38% breastfed for 1 to 2 months, and 24.18% for 6 months or more. However, the relationship of postpartum depression and breastfeeding was not significant with a P-value > 0.05. 84.97% of the included mothers had the same or greater weight than before pregnancy. In conclusion, mothers in King Abdulaziz University Hospital are well adherent to breast milk feeding. The association of breastfeeding to weight loss was not observed as suggested. Mothers with postpartum depression were less adherent to the practice of breastfeeding.

The MC4R genotype is associated with postpartum weight reduction and glycemic changes among women with prior gestational diabetes: longitudinal analysis

The genetic variants near the Melanocortin-4 receptor gene (MC4R), a key protein regulating energy balance and adiposity, have been related to obesity and glucose metabolism. We aimed to assess whether the MC4R genotype affected longitudinal changes in body weight and glucose metabolism biomarkers among women with prior gestational diabetes mellitus (GDM). The MC4R genotype, postpartum weight reduction, and glycemic changes between after delivery and pregnancy were assessed in a cohort of 1208 Chinese women who had experienced GDM. The adiposity-increasing allele (C) of the MC4R variant rs6567160 was associated with greater postpartum increase of HbA1c (β = 0.08%; P = 0.03) and 2-hour OGTT glucose concentrations (β = 0.25 mmol/L; P = 0.02). In addition, we found an interaction between the MC4R genotype and postpartum weight reduction on changes in fasting plasma glucose (P-interaction = 0.03). We found that the MC4R genotype was associated with postpartum glycemic changes; and the association with fasting glucose were significantly modified by postpartum weight reduction in women who had experienced GDM.

Plasma ω-3 fatty acids in pregnancy are inversely associated with postpartum weight retention in a multiethnic Asian cohort ,

Background: Studies have demonstrated associations between polyunsaturated fatty acids (PUFAs) and adiposity. It is unclear whether PUFAs in pregnancy have an effect on maternal weight retention after childbirth, which can contribute to long-term obesity.Objective: We examined the association of maternal plasma PUFAs in pregnancy with 18-mo postpartum weight retention (PPWR) in a multiethnic Asian cohort.Design: We studied pregnant women (n = 653) recruited between June 2009 and September 2010 from a prospective cohort. At 26–28 wk of gestation, plasma phosphatidylcholine PUFA concentrations were measured and determined as percentages of total fatty acids (FAs). PPWR was calculated based on the difference between measured weight at the first antenatal clinic visit and at 18 mo postpartum.Results: The median retained weight of women was 0.90 kg (IQR: −1.40, 3.25) at 18 mo postpartum. Of 653 women, 544 women (83.3%) had PPWR of <5 kg and 109 (16.7%) had PPWR of ≥5 kg. In adjusted linear regression models, higher plasma eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and total ω-3 (n–3) PUFA concentrations were associated with lower PPWR [EPA: β = −0.62 kg/1% increase of total FAs (95% CI: −1.18, −0.05); DHA: β = −0.24 kg/1% increase (95% CI: −0.45, −0.02); total ω-3 PUFAs: β = −0.20 kg/1% increase (95% CI: −0.36, −0.03)], whereas a higher ratio of plasma ω-6-to-ω-3 PUFAs was associated with a higher PPWR [β = 0.21 kg/unit increase (95% CI: 0.05, 0.36)].Conclusions: Higher plasma percentages of ω-3 PUFAs and a lower ratio of ω-6-to-ω-3 PUFAs in the late-second trimester of pregnancy are associated with less weight retention at 18 mo postpartum. This may offer an alternative strategy to assist postpartum weight reduction by increasing EPA and DHA status together with a decreased ratio of ω-6-to-ω-3 PUFA through diet or fish-oil supplementation during pregnancy. This study was registered at clinicaltrials.gov as NCT01174875.

The Effect of Body Mass Index on Pelvic Floor Support 1 Year Postpartum.

Elevated body mass index (BMI) is associated with the incidence, prevalence, and progression of pelvic organ prolapse (POP). This study investigated the effect of peripartum BMI on pelvic floor support 1 year postpartum (PP1y). One hundred eight nulliparous women had their BMI recorded and underwent POP assessments using the Pelvic Organ Prolapse Quantification System at baseline, third trimester (36th to 38th week of pregnancy [G36-38w]), and PP1y. Pelvic organ prolapse was defined as ≥stage II. Women gained on average 1.9 kg between baseline and PP1y. After adjustment, increasing BMI PP1y was associated with increasing anterior wall descent (P < .0001) and higher odds of having POP PP1y (odds ratio: 1.41, 95% confidence interval: 1.01-1.97, P = .045). Trial of labor compared to unlabored cesarean delivery, POP G36-38w, and decreased fetal weight were independently associated with anterior vaginal wall laxity PP1y. Our finding suggests that postpartum BMI influences pelvic floor laxity 1 year after delivery. Postpartum weight reduction may serve as a strategy for POP prevention in some women.

The Associations of Maternal Weight Change with Breastfeeding, Diet and Physical Activity During the Postpartum Period.

To determine the association between breastfeeding practices, diet and physical activity and maternal postpartum weight. This was a secondary data analysis of a randomized community trial on beneficiaries of the Programa de Desarrollo Humano Oportunidades, recently renamed Prospera (n = 314 pregnant women), without any diseases that could affect body weight. Generalized estimating equations were used to determine the association between postpartum weight change and changes in diet, physical activity and type of breastfeeding. The mean postpartum weight change from the first to the third month was 0.6 ± 2.2 kg. Women who breastfed exclusively for 3 months had a 4.1 (SE = 1.9) kg weight reduction in comparison with women who did not provide exclusive breastfeeding or who discontinued breastfeeding before 3 months (p = 0.04). There was no association between postpartum weight change and physical activity (p = 0.24) or energy intake (p = 0.06). Exclusive breastfeeding was associated with maternal postpartum weight reduction. These results reinforce the World Health Organization recommendation of exclusive breastfeeding during the first 6 months of life in order to reduce the risk of weight retention or weight gain in postpartum women. It has been well established that exclusive breastfeeding is beneficial for both infants and mothers, but promoting breastfeeding as a strategy to promote postpartum weight loss is of paramount importance, especially in countries like Mexico where excessive weight in women of reproductive age is a public health problem.

Genetic Predisposition to Polycystic Ovary Syndrome, Postpartum Weight Reduction, and Glycemic Changes: A Longitudinal Study in Women With Prior Gestational Diabetes.

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women and a major female-specific risk factor of obesity, impaired glucose tolerance, and diabetes. We examined whether the genetic variation predisposing to PCOS affected glycemic changes in women with prior gestational diabetes mellitus (GDM) and whether such an effect was modified by changes in body adiposity, especially during and after pregnancy. This is a longitudinal study in Tianjin, China. We genotyped 7 genome-wide association study-identified PCOS single nucleotide polymorphisms and assessed gestational weight gain and changes in glycemic traits and weight at 1 to 5 years postpartum in 1133 women with prior GDM. The main outcome measure was postpartum glycemic changes. The PCOS genetic risk score significantly interacted with postpartum weight reduction on changes in fasting glucose and 2-h glucose (P for interaction = .032 and .007; respectively) after multivariable adjustment. In women with postpartum weight reduction of ≥ 5 kg/y, the genetic risk score was associated with decreased fasting and 2-h glucose, whereas an opposite genetic effect was found in women who lost less weight. The association between postpartum weight reduction and glycemic improvement was more significant among women with a higher genetic risk score. In a large cohort of Chinese women with a history of GDM, our data for the first time indicate that the genetic predisposition to PCOS may interact with postpartum weight reduction on long-term glycemic changes, emphasizing the importance of postpartum weight management in prevention of diabetes in this subgroup of women.

Maternal outcomes of breast milk feeding in King Abdulaziz University Hospital, Saudi Arabia

Introduction: Breastfeeding is the optimum method of nutrition for the growing infant. It has been suggested that breastfeeding also benefits the mothers. It is proposed that lactation is an efficient way of promoting postpartum weight loss. Furthermore, postpartum depression can be challenging for both mothers and their infants. It is likely that postpartum depression leads to early cessation of breastfeeding. Breastfeeding may alter the risk of depression. Objectives: To measure the adherence and frequency of breast milk feeding among mothers in King Abdulaziz University Hospital (KAUH), identify the relationship between breastfeeding and the development of postpartum depression and calculate the postpartum weight reduction percentage in comparison with prepregnancy weight. Materials and methods: A cross-sectional study was conducted in KAUH among 150 mothers, whose infants are less than 2 years of age. Data on the pattern of feeding and the suggested outcomes were collected by interviewing the mothers using a standard questionnaire designed for the study and the Hamilton Depression Rating Scale. Measurement of height, weight and waist circumference were also carried out. Simple descriptive statistical analysis, percentages for categorical data and mean (standard deviation) for continuous data, were produced using SPSS (Statistical Product and Service Solutions; SPSS Inc., Chicago, IL, USA). Chi-squared test and Fisher’ s exact test were utilized to compare between two proportions. A P -value 0.05) and 84.97% of the mothers had the same or more weight than before pregnancy. Conclusions: Mothers in KAUH have a high frequency of breast milk feeding and are well adherent. The outcomes of breast milk feeding in mothers in the context of weight loss were not observed. Depressed women were less adherent to the practice of breast milk feeding. Acknowledgements: Dr Hala Mosli for supervising this project.

A Comparison of Mediterranean-Style and MyPyramid Diets on Weight Loss and Inflammatory Biomarkers in Postpartum Breastfeeding Women

Of postpartum women, 15%-20% retain ≥ 5 kg of their gestational weight gain, increasing risk for adult weight gain. Postpartum women are also in a persistent elevated inflammatory state. Both factors could increase the risk of obesity-related chronic disease. We hypothesized that breastfeeding women randomized to a Mediterranean-style (MED) diet for 4 months would demonstrate significantly greater reductions in body weight, body fat, and inflammation than women randomized to the U.S. Department of Agriculture's (USDA) MyPyramid diet for Pregnancy and Breastfeeding (comparison diet). A randomized, controlled dietary intervention trial was conducted in 129 overweight (body mass index [BMI] 27.2 ± 4.9 kg/m(2)), mostly exclusively breastfeeding (73.6%) women who were a mean 17.5 weeks postpartum. Dietary change was assessed using a validated Food Frequency Questionnaire (FFQ) before and after intervention as well as plasma fatty acid measures (gas chromatography/flame ionization detector [GC/FID]). Anthropometric measurements and biomarkers of inflammation, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), also were assessed at baseline and 4 months via enzyme-linked immunosorbent assay (ELISA). Participants in both diet groups demonstrated significant (p<0.001) reductions in body weight (-2.3 ± 3.4 kg and -3.1 ± 3.4 kg for the MED and comparison diets, respectively) and significant (p ≤ 0.002) reductions in all other anthropometric measurements; no significant between-group differences were shown as hypothesized. A significant decrease in TNF-α but not IL-6 was also demonstrated in both diet groups, with no significant between-group difference. Both diets support the promotion of postpartum weight loss and reduction in inflammation (TNF-α) in breastfeeding women.

Blood Pressure Changes during Pregnancy: Impact of Race, Body Mass Index, and Weight Gain

To investigate the effect of race, body mass index (BMI), and weight gain on blood pressure in pregnancy and postpartum. Secondary analysis of pregnant women aged 14 to 25 who received prenatal care at a university-affiliated public clinic in New Haven, Connecticut and delivered singleton term infants (n = 418). Longitudinal multivariate analysis was used to evaluate blood pressure trajectories from pregnancy through 12 weeks postpartum. Obese and overweight women had significantly higher blood pressure readings as compared with women with normal BMI (all p < 0.05). African American women who had high pregnancy weight gain had the greatest increase in mean arterial and diastolic blood pressures in pregnancy and postpartum. Blood pressure trajectories in pregnancy and postpartum are significantly affected by race, BMI, and weight gain. Given the young age of this cohort, targeted efforts must be made for postpartum weight reduction to reduce cardiovascular risk.

Assessment of protein intake during pregnancy using a food frequency questionnaire and the effect on postpartum body weight variation

The aim of this study was to investigate the effect of protein intake during pregnancy on postpartum weight variation. This was a prospective cohort study with 421 women interviewed at 15 days (baseline) and 2, 6, and 9 months postpartum. Data on diet were obtained using the food frequency questionnaire, focusing on the second and third trimesters. Protein intake was considered adequate when women consumed ≥ 1.2g of protein per kg body weight, and inadequate when < 1.2g/kg. The study adopted the mixed effects model for repeated measurements over time. The results showed a mean postpartum weight loss of 0.409kg/month (±0.12) (p < 0.01). Women with adequate protein intake during pregnancy lost an additional 0.094kg/month (±0.04) during postpartum (p = 0.03) when compared to women with inadequate intake. The model was adjusted for energy, % body fat, stature, age, schooling, skin color, and smoking. Recommended protein intake during pregnancy favored postpartum weight reduction.

Multiparity is Associated With High Motivation to Change Diet Among Overweight and Obese Postpartum Women

Pregnancy is associated with weight gain and obesity. The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women. Active Mothers Postpartum is a randomized, controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, body mass index category, and breastfeeding status. Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared with primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding. Although risk for obesity is incurred starting with a woman's first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding.

Contraceptive use by obese women 1 year postpartum

Background Obese women have higher rates of pregnancy complications, making the prevention of unintended pregnancies in this group of particular importance. Study Design We performed a secondary analysis of data from Active Mothers Postpartum (AMP), a randomized controlled trial aimed at postpartum weight reduction. We assessed contraceptive use among 361 overweight/obese women 12 months postpartum. Logistic regression was used to model the effect of body mass index (BMI) categories on effective contraceptive use (intrauterine, hormonal or sterilization methods) while adjusting for potential confounders including age, race, parity, breastfeeding, education and chronic illness. Results Effective contraceptive use was reported by 45% of women. In the multivariable model, women with a BMI ≥35 kg/m 2 were less likely to use effective contraception than women with a BMI <30 kg/m 2 (OR 0.5, 95% CI 0.3–0.8). There was a trend towards less use of effective contraception among women with a BMI 30–34.9 kg/m 2 as compared to women with a BMI <30 kg/m 2. Conclusion At 12 months postpartum, obese women were less likely to use effective contraceptive methods than overweight women. Although certain contraceptive methods may be preferred over others in this population, providers should reinforce the importance of effective contraception to avoid unintended pregnancies in obese women.